FOR PEOPLE AFFECTED BY NATURAL DISASTER, TERRORIST ATTACK AND OTHER TRAUMATIC LOSSES

The earthquake and tsunami that hit communities in Japan on 11 March 2011 may well affect many people with family ties to these places, as with the earthquake that shook Christchurch on South Island, New Zealand, on 21 February 2011.

The Queen, Prime Minister David Cameron and Foreign Secretary William Hague have expressed their condolences following the earthquake in Japan - please click here for the statement on the Foreign and Commonwealth Office website. The FCO also has current advice about contacts with and travel to the area.

All bereavements are traumatic but some more so than others. A traumatic loss is one that is unexpected, untimely and often associated with horrific or frightening circumstances. We hope that the following, written by Colin Murray Parkes, OBE, MD, FRCPsych., Life President of Cruse Bereavement Care, with the assistance of Cruse staff, will help those coming to terms with difficult losses.

INTRODUCTION
We hope that this information will go some way to mitigate some of the problems that continue to add to the suffering of people bereaved by disasters of all kinds.  In this paper we explain why a traumatic loss can give rise to special problems for which help may be needed from those who are our normal source of support at times of loss, our family and friends, and we indicate where such help can be found.

For most people the two main sources of security in our lives come from having a family who care, and a home. The loss of a home can undermine that security and be a real cause for grief. Even if we are rapidly re-housed it may be a long time before the new place feels like home. At such times friends and neighbours are more than ever important and it is a good idea to relocate them together when possible.  An intact community can make up for a lost building.

COPING WITH TRAUMATIC LOSS
All bereavements are traumatic but some are more traumatic than others.  A traumatic loss is one that is unexpected, untimely and often associated with horrific or frightening circumstances.

Whenever a traumatic loss of someone we love takes place, there are three types of problems that may arise:

1. Problems of Trauma
2. Problems of Grieving
3. Problems of Anger and Self-Reproach
4. Problems of Change

We will consider each of these in turn:

1.  Problems of Trauma

“I can’t believe it’s true”
Losses for which we are quite unprepared, particularly if we are unable to be present or to hold or touch the lost person, are difficult to make real.

What helps?
It takes a long time to take in what has happened and to form a balanced judgement on the basis of the evidence we are given. Spend time talking it through with others and don’t worry that you are being a burden to them, that’s what friends are for. Many people find it helpful to visit the place where the disaster took place, to talk with others involved, to place a wreath in a significant place, and to attend memorial services or other rituals of remembrance. In the end, there may be aspects of the loss that will never be explained. Be prepared to live with the uncertainty of not knowing, we cannot explain or control everything and, fortunately, we don’t have to.

“I can’t get it out of my head”
Many people are haunted by pictures, in their minds, of the traumatic event. While this is most likely to become a problem if they witnessed the event, it can also arise from television or other pictures which ‘bring home’ the awfulness of the way a person might have died. Such images may occur unbidden or, in distorted form, as recurrent nightmares, or they may be triggered by any reminder of the loss, e.g. loud noises, cries or shouts. So painful are the images that some people go to great lengths to avoid any such reminders. They may shut themselves up at home, avoid talking of the loss, and distract themselves with hectic activity. Although, to some degree this kind of reaction is not uncommon and will improve with time, in severe form it may become so painful and disabling that it justifies the term ‘Post-Traumatic Stress Disorder’ (PTSD).

What helps?
Haunting images can sometimes be assuaged by talking to others, going over the events again and again until you get used to them. The images will not disappear but they will become less painful. It becomes easier to live with them; you are back in control. If this is not sufficient to make them tolerable or if the images are stopping you from grieving or getting on with your life, then you should consult a psychiatrist or psychologist. Very effective treatments for PTSD have been developed in recent years and it is wise to take advantage of these. They do not necessarily require the prescription of medication, although this may help.

2.  Problems of Grieving

“I feel numb”
Numbness is our mind’s way of protecting itself from mental pain that threatens to over-whelm us. Sometimes it may be so pronounced that we are unable to think clearly, become confused and lose our bearings, at other times we may be unable to express feelings of any kind. In an emergency it is such ‘dissociation’ that enables us to keep going, searching for a lost person or engaging in the rescue of others. It is only if it continues after the disaster is over that it becomes a problem. Usually this reflects a fear that, if we do not keep our feelings firmly under control, they will take control of us, we shall cry or become a helpless baby. 

What helps?
Grief is the natural response to the loss of a loved person. It is more likely to give rise to problems if it is bottled up than if it is expressed. At times of loss it is normal and appropriate to express grief in any way that feels natural. Some people need to cry, others will rage and others just talk endlessly about what has happened. Try to find someone you can trust who will be a good listener and don’t worry if, for a while, you look or feel helpless, that will pass. In grieving we do not forget the people we love, we gradually find new ways to remember them. Memories of the past are sometimes painful but they are our treasure, it is best not to bury them for too long. Paradoxically, if we allow ourselves to lose control of our feelings, for a while, we shall find ourselves better able to live with and to control them.

“I can’t stop crying”
Grief goes on much longer than most people expect. We need to recognise that fact and not expect too much of ourselves. This said, there are some griefs which get stuck. Sometimes this reflects our need to punish ourselves –“Why should I be happy now that he or she is dead?”  This is most likely to arise if it is a child who has died, if we blame ourselves for their death or for not being there for them when needed. At other times it reflects long-standing feelings of depression or helplessness, which are easily undermined by a traumatic life event.

What helps?
Grief is not like the measles, we do not go back to being the person we were before our loss. We learn to live with it, and, little by little, the pain will diminish. Grief is not a duty to the dead, those we love would not want us to suffer. Again, talking it through with a friend or bereavement support worker from Cruse Bereavement Care, will usually help but, if that is not sufficient or we feel perpetually depressed or suicidal, we should not hesitate to seek specialist help. Several treatments including Cognitive Therapies, Psycho-therapies and Anti-depressant medications will be of help and it is worth discussing with your GP which of these alternatives are available in your area and appropriate to meet your needs. Do not give up.

3.  Problems of Anger and Self-Reproach

“I feel so angry”
Anger is a very natural reaction to outrageous loss, particularly if it was caused by terrorism or other human agency. It may be directed appropriately against the perpetrators of the trauma or inappropriately against all authorities or against the people nearest to hand. In our desperation we may find ourselves hitting out wildly at the people we love the best. Occasionally ill-directed anger may even feed into or bring about a cycle of violence.

What Helps?
Remember that anger can be a force for good if it is controlled and directed where it can do good rather than harm. Try to hold back from impulsive outbursts and, if you have said or done things that have hurt others, don’t be too proud to apologise. They will understand.

“I blame myself, I feel so guilty”
None of us is perfect and it is easy to seize on something that we did or didn’t do in our attempt to find someone to blame for the disaster that has happened. Consequently we end up blaming ourselves. At the back of our minds we may even cling to the idea that, if we punish ourselves we will make things right again and get back the person we have lost. Sadly this magical thinking is doomed to fail.

What Helps?
Sooner or later we have to accept that what has happened is irrevocable and that self-punitive grieving will change nothing. Friends will often say ‘You shouldn’t blame yourself’, and maybe they are right. But we do not choose the way we feel. Guilt and anger are not feelings that can be switched on and off at will. Rather we should try to find a creative use for our grief, to bring something good out of the bad thing that has happened.

4.  Problems of Changing

“I feel so frightened”
We all know that disasters happen, but they don’t happen to me. Most of the time we go through life with confidence that we are safe, protected from harm and immune from the ‘slings and arrows of outrageous fortune’. Then disaster strikes, all in a moment the world has become a dangerous place, we can take nothing for granted, we are waiting for the next disaster, “My world has been turned upside down”.

Fear causes bodily symptoms – tense muscles, racing heart, sweating, breathlessness, sleeplessness, - all symptoms which, in the environment in which we evolved would have helped us to stay alive in situations of danger. But in today’s world they do no such thing and are more likely to be misinterpreted as symptoms of illness. This adds to our fears and may set up a vicious circle of fear ® symptoms ® fear.

What helps?
The first and most important thing is to break the vicious circle. Recognise that the symptoms of fear are a sign of normality, at such times a racing heart is a normal heart, headaches, back aches, indigestion, even feelings of panic, are natural reactions that will decline as time passes, they are not symptoms that will lead to something worse. In addition you are not as helpless as you feel. Relaxation exercises, meditation techniques, aroma-therapy or whatever helps to relax you will put you back in control.

This said, you should not expect to go back to being the secure, confident  person that you were before the disaster struck. You have learned the hard way that life is never - and never was - completely safe. You have lost the illusion of invulnerability and will never quite regain it. You are older and sadder as a result. But you are also more mature. You have learned that life has its dark side, but that does not mean that you need live your life in perpetual fear. The world today is no more dangerous than it was before the disaster. Previously you had an illusion of safety, the feeling of danger is equally illusory, it will grow less. During World War II this was called the ‘Near-Miss Phenomenon’. It affected people who had been closely missed by a bomb, but it passed. Human beings evolved to cope with a much more dangerous world than the one in which we live today. You, and those with you, will survive.

“Life has lost its meaning”
Each person’s sense of purpose and direction in life arises from a hundred and one habits of thought, assumptions about the world that we take for granted. ‘I know where I’m going and I know who’s going with me’. Then, all of a sudden, we can take nothing for granted any more. Perhaps the person who died is the one we would have turned to at times of trouble – and now, when we face the biggest trouble in our lives, they are not there, or, if they are, they are so overwhelmed by their own grief that we cannot burden them with ours. Even God, who seemed to keep us safe in the past, has let us down. Chaos reigns.

What helps?
Those who have a religious faith may find it helpful to seek pastoral support, others may find spiritual help outside of formal religious frameworks.

When faced with a disaster of this magnitude we must realise that it takes time and hard work to adjust. It is rather like learning to cope with the loss of a limb. For a while we will feel crippled, mutilated, as if a part of ourselves is missing. We feel as if we had lost every good thing that relied on the presence of the person we love for its meaning. But take heart, all is not lost. Now is the time to take stock of our lives, to ask ourselves what really matters? When we do that we may be surprised to find that many of the things that made sense of our lives when the lost person was with us continue to make sense of our lives now that they are away. Indeed they may make more sense because they are away. When people say “He (or she) lives on in my memory”, this is literally true.

Colin Murray Parkes

Please click here for the pdf file for: People Affected by Natural Disaster, Terrorist Attack and other Traumatic Losses (pdf 35KB)

A Guide to Coroners' Inquests:
a film (about 30 minutes) has been made to help those who face the prospect of a coroner's inquest into the death of a loved one better understand the processes. Please click here to watch

We have a series of broadcasts which we hope will both help and inform.

You may find other useful publications from our online shop

Click here for the Disasters Emergency Committee website
The British umbrella organisation which launches and coordinates responses to major disasters overseas.

Home Page